Sedating Endo Patients, Staffing an OR
Re: "Ask the Experts" (August, page 22). There is general consensus on the definition of conscious sedation, commonly called moderate sedation, that the major accrediting agencies use: "a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained." (AAAHC 2004 Handbook) This definition doesn't mention specific drugs because sedation is a continuum and you can use any of the drugs mentioned in the answer for mild, moderate or deep sedation. Clearly propofol falls into the deep sedation or general anesthesia definition. Nursing license and state nurse practice acts generally restrict RNs from administering deep sedation or general anesthesia unless they're also CRNAs. A joint position statement of the ASGE and SGNA on sedation (go to writeOutLink("www.sgna.org",1)) further clarifies RNs' responsibilities.
The answer to the question on staffing in the OR notes, "techs must be credentialed if they're employees of your facility." Techs should be credentialed if they work in your facility as the employee of the surgeon, or as independent contractors paid by the surgeon or your facility. But if they're employees of your facility, their job description should spell out their training, duties and responsibilities - just like for any other clinical employee (RNs, LPNs and CSTs). Also, MAC (monitored anesthesia care) refers to moderate or deep sedation administered by a CRNA or anesthesiologist who also is continuously monitoring the patient. A second RN isn't necessary for patient monitoring. If the answerer was referring to moderate sedation/conscious sedation administered by an RN under the medical direction of the surgeon or endoscopist, then the guidelines mentioned above would apply.
Jack Egnatinsky, MD
Anesthesiologist, AAAHC surveyor, FASA president
Christiansted, U.S. Virgin Islands
My Time as a "Rent-a-nurse"
I went from eight years of OR staff nursing to two years as a head nurse, to 10 years as a director and then to a year of registry nursing. Now I am happily back to being a head nurse in the OR.
Since the OR was the only place I'd worked and I needed the income to sustain my family, I didn't have the option of retiring or taking a sabbatical to fix my in-a-rut mentality. I truly desired to renew, restore and rekindle a positive feeling for the profession. This is why I gave registry nursing a try. Registry nursing let me work full-time, keeping my clinical skills sharp, and yet I could stay out of the facility environment and the political and personal crossfire inherent in the OR environment. My time spent as a "rent-a-nurse" was more fun than I could have ever anticipated. For the first time I felt that I was working because I wanted to. It was refreshing to walk away after eight hours, knowing that my obligation was met that day, and it was my choice to come back tomorrow. Over that year, I did find that nursing was where I needed to be.
Robin Homolak, RN, BSN, CNOR
OR Head Nurse
West Anaheim Medical Center
Re: "Does Your Facility Need a Facelift?" (September, page 34). The article concerning facility facelifts was very interesting and creative. I like the patient curtains with the outdoor design, the backlit ceiling panels and the OR floor art.
Sandra K. Berger, RN, MSN, CNOR
Director of Nursing
The Center For Surgery
Suburban Surgery Center of DuPage
Could you tell me who manufactures cubicle curtains with a nature scene on them? We are interested in them for one of our facilities.
Mary Sturm, RN
Director of Nursing
Sioux Falls Surgical Center
Sioux Falls, S.D.
Editor's note: Catalina Curtain Company makes Sereneview cubicle curtains. The curtains, which surround patients with nature landscapes by Catalina Island-based photographic artist Ernesto Rodriguez, are designed to enhance healing by reducing stress. For more information, call (888) 515-6578 or visit writeOutLink("www.sereneview.com",1).